I'm aware of acetaminophen's down sides, and yet recently I was taking it combined with 2 other medications at the time.
Why? Because all three medications are recommended for dealing with the issue I had. (Alone and in combination)
The moment it wasn't helping further? Done.
There is this broken idea, particularly apparent in North America, but in western society that more is better for many things. It's not.
More pain killers don't do anything if they max out the relief they can give you, overloading their mechanism doesn't reduce anything, but taxing your liver or your kidneys.
All medications are potentially toxic, your body wants to dispose of them. In appropriate dosages they will benefit you, but more isn't inherently better.
Even water can kill you in sufficient quantity.
We do the same with diet; where someone declares one ingredient in a meal healthier than another; it isn't. A single ingredient isn't better or worse for you in a meal. Your diet however can be good or bad; over time that matters.
I always thought a simple over-the-counter supplement (NAC) being the cure for an overdose was so cool. It's a pretty cool substance in a lot of ways, and this is a great spur to myself to research it more thoroughly.
Apparently for some people it also helps with lessening tolerance for their ADHD meds, but I'm not so sure about that.
I'd believe it. I first heard of NAC on the nootropic subreddit in a past lifetime. The benefits vary, but generally it's a safe thing with a low chance of making anything worse, but a possibility to improve things. Many neurodivergent folk have written about how they benefit.
I'd give more info on the exact benefits they found (iirc OCD and rumination loops could be broken more easily), but unfortunately my memory is failing me.
Usually here in Canada it's available in pill form which I find less effective.
There is a limit to the amount of opioids they will prescribe you, even if you are in mind shattering pain. For instance while attempting to get your dental insurance to actually cover a treatment you may find yourself between risking organ damage or risking $5000+ in ER visit bills only to have them refuse to give you anything but Tramadol.
I guess it is much better than the situation before that, where you paid $5000+ and they also gave you an opioid addiction.
20 not-especially-large tablets
Suppose your arthritis is acting up, so you start taking Tylenol 8hr Arthritis Pain[1]. That's 2 tablets every 8 hours. They're extended-release with 650mg per tablet. A total of 3900 mg in 24 hours.
A few days later you get the flu, so you decide to add what seems like a completely different medication: Theraflu Flu Relief Max Strength[2]. It has a cough suppressant and an antihistamine. But each caplet also contains 500 mg of acetaminophen. It says to take 2 caplets every 6 hours, so you take 8 of them in 24 hours[3]. That's another 4000 mg.
Between the two, you're at 7900 mg.
Then you wake up in the morning and take both medications, but 30 minutes later you've forgotten you took them. You're not thinking straight because you're sick. So you accidentally take a second dose. That additional 2300 mg brings your total to 10200 mg.
---
[1] https://www.tylenol.com/products/arthritis/tylenol-8hr-arthr...
[2] https://www.theraflu.com/products/day-night-flu-relief-max-s...
[3] You weren't supposed to take 8 of them, though. If you'd read the label very carefully, you'd have seen it also says not to exceed 6 in a 24-hour period.
... Suddenly I'm maintaining a continuous note of when I'm taking which medicine to avoid crossing safe limits (which I anyway was crossing most days).
I was only told to take 2 paracetamols a day (bullshit dose, I'd be waking up from the pain even with more pain meds).
"Diclofenac for rare use" - well, if nothing else is touching the pain, is it an emergency?
Eventually after forever I was able to transition to Ibuprofen + paracetamol. And I already have a health condition which is heavy on my kidneys... pain management can be absolutely crazy.
Speaking as someone who is not-infrequently in significant pain, I sincerely hope that you never have to.
edit: https://www.24pharma.nl/paracetamol-eg-1000mg-120-tabletten
Meanwhile, it's funny that it seems like acetaminophen should safer in more scenarios, but the other has a lot of overdoses with typical use, I guess that's why there's a gap between the two, because ODs are apparently a lot more common or at least more legible than problems caused by the other drug.
I arrived in Aus in 2021 and was amazed to be able to buy a pack of 40+, coming from the UK where the limit had been in place for some years.
It's the usual public health balancing act of help vs harm.
You can overdose on water too, they haven't banned 5-gallon jugs (yet).
Harm reduction is about shifting probability distributions, not guaranteeing outcomes. Kids can still get into pill bottles with childproof medication caps, but accidental ingestion of aspirin by children reduced by 40-55% after they were mandated. [0]
I didn't know about this acetaminophen risk. So I'll be looking for alternatives. Ibuprofen is for inflammation and not headaches. Naproxen is a candidate.
FDA FAERS is the official dataset for reporting Adverse events from taking a drug. FDA adverse event reports about 2 million cases and 4,067 unique drugs
I agree the results are not easy for non medical professionals to interpret correctly. For example DEATH is very strong with Parecetemol and so is DEPENDECE. The latter because from AI it is a confounding factor. Acetaminophen/parecetemol is frequently co-formulated with opioids (like Hydrocodone or Codeine). The "Dependence" signal is likely attributed to the opioid, not the Acetaminophen itself...
Adverse Event Acetaminophen PRR (95% CI) Acetaminophen n ibuprofen PRR (95% CI) ibuprofen n ACUTE KIDNEY INJURY 0.87 (0.80-0.96) 498 4.27 (3.91-4.67) * 483 ANAPHYLACTIC REACTION 0.61 (0.51-0.72) 122 9.85 (8.90-10.90) * 382 ANGIOEDEMA 1.31 (1.13-1.53) 170 15.26 (13.77-16.92) * 378 DEATH 1.44 (1.40-1.49) 3958 0.07 (0.06-0.10) 42 DEPENDENCE 237.12 (231.51-242.88) * 39679 0.02 (0.01-0.05) 4 DEPRESSION 2.18 (2.05-2.31) * 1157 0.39 (0.29-0.52) 43 DRUG EFFECTIVE FOR UNAPPROVED INDICATION 16.77 (16.11-17.46) * 3180 44.17 (42.18-46.25) * 1921 DRUG HYPERSENSITIVITY 0.57 (0.51-0.64) 327 3.30 (2.98-3.65) * 372
This is semi recent research on how it might be blocking pain
The positive of it is it got me in the habit of logging whenever I take it, either in a note on my phone or just a sheet of paper I place on my dresser under the bottle. This helps make sure I stay under the 3-4g/d limit.
Last year I was diagnosed with a rare headache disease (NDPH). We thought it completely came out of nowhere, but I had logs in my phone recording headaches and acetaminophen use intermittently from a few weeks prior. This proved useful in the diagnosis.
Moral of the story: log when you take it to avoid overdosing. Combine that with some basic symptom logging (like 1 line, 10 words or less). You never know when that might be useful for your doctors later on.
Rationalizations like “they probably put the limit way lower than the real limit so idiots don’t OD themselves, so I can safely take a bit more” become very attractive when you’re in a lot of pain.
I've never once thought about taking more than the recommended dosage of acetaminophen, largely because I had no expectation that it would provide additional benefit..
In reality, I try to consume 1/2 doses of anything or nothing at all, unless it's a serious medical treatment being administered by a professional.
An interesting thing with ibuprofen is that at the regular dose of 400mg it inhibits pain but if you take 1600mg it doesn't inhibit much more pain than the 400mg dose, but the inflammatory effect does increase significantly. A lot of people don't know that and take too much thinking it scales linearly.
1g of Paracetamol with 400mg of Ibuprofen gives similar pain relief as 2mg of IV morphine.[1]
I avoid both and stick with naproxen sodium. Any issues with that one? Lasts the longest too.
I would definitely have a chat with a doctor about it.
Unrelated, but it feels like an oversight that this article said nothing about how both acetaminophen and ibuprofen reduce fevers. They aren't used solely for reducing pain.
IBU: -stomach -kidneys -bp+ -clotting --NERD --NECD --NEUD --SNIUAA --SNIDR --DRESS
APAP: -liver --DRESS
-- extreme, rare side-effects
If you don’t realize your kidneys are already damaged you might die from kidney failure because of ibuprofen.
I'll second the claim that no doctor at any point in his life had told him the risks of doing that, and many encouraged the use of ibuprofen over any other alternative (including the alternative of not using OTC painkillers every single day).
Acetaminophen is part of ECA stack weight loss formula, while article says not OK with fasting. Either way, more safe solutions are known these days.
Max dose combination (IBU/APAP FDC) can be useful as a substitute in emergency therapeutic situations compared to opiates. Not recommended ordinarily because of liver, kidney, and stomach impairment.[0]
Taking ibuprofen with questionable stomach condition may want to consider taking a famotidine adjuvant or duexis [1] or acetaminophen instead.
Overdose treatment of acetaminophen poisoning is the stinky N-acetylcysteine (NAC), so that maybe worth stocking whenever Tylenol is kept in a house with kids. Overdose of ibuprofen is palliative, requiring IV fluids and dialysis.
0. https://www.researchgate.net/publication/382639515_Ibuprofen...
I Am Not A Doctor And This Is Not Medical Advice.
(I think?).
Ibuprofen damages the kidneys -- and that damage is often permanent. The little filtering devices inside the kidneys don't grow back once they're destroyed. A dog who survives the poisoning can end up with lifelong kidney disease, which means special diets, more frequent vet visits, and a shorter life than she should have had.
(I watched this happen to my own dog after a house sitter stepped on her paw and gave her ibuprofen to "help." My dog lived, but she needed a special diet for the rest of her life.)
Acetaminophen wrecks the liver, and it also can damage red blood cells so they can't carry oxygen properly. A poisoned dog may get lethargic, vomit, start to breathe heavily... This is especially dangerous for older dogs, or any dog whose red blood cells are already compromised, by conditions like IMHA.
Tylenol/acetaminophen is good for fever which NSAIDs won't help. Otherwise, take both and alternate their dosing times for better pain coverage.
A fever is not dangerous within normal parameters, except for being dangerous to the virus and bacteria that threaten the body. Your body runs a fever because it engages in a battle to the death with these microbes.
If you defeat the body's own defenses by lowering the fever, for example if you are a nervous mother who hates her baby's fussing, or if you're hospitalized and the nurses are laser-focused on "number go down" treatments, then you can expect to be ravaged by the contagion for much longer than expected.
The medications that change who we are - https://www.bbc.com/future/article/20200108-the-medications-...
Excerpt:
Mischkowski’s own research has uncovered a sinister side-effect of paracetamol. For a long time, scientists have known that the drug blunts physical pain by reducing activity in certain brain areas, such as the insular cortex, which plays an important role in our emotions. These areas are involved in our experience of social pain, too – and intriguingly, paracetamol can make us feel better after a rejection.
Mischkowski wondered whether painkillers might be making it harder to experience empathy
And recent research has revealed that this patch of cerebral real-estate is more crowded than anyone previously thought, because it turns out the brain’s pain centres also share their home with empathy.
For example, fMRI (functional magnetic resonance imaging) scans have shown that the same areas of our brain become active when we’re experiencing “positive empathy” –pleasure on other people’s behalf – as when we’re experiencing pain.
Given these facts, Mischkowski wondered whether painkillers might be making it harder to experience empathy. Earlier this year, together with colleagues from Ohio University and Ohio State University, he recruited some students and spilt them into two groups. One received a standard 1,000mg dose of paracetamol, while the other was given a placebo. Then he asked them to read scenarios about uplifting experiences that had happened to other people, such as the good fortune of “Alex”, who finally plucked up the courage to ask a girl on a date (she said yes).
The results revealed that paracetamol significantly reduces our ability to feel positive empathy – a result with implications for how the drug is shaping the social relationships of millions of people every day. Though the experiment didn’t look at negative empathy – where we experience and relate to other people’s pain – Mischkowski suspects that this would also be more difficult to summon after taking the drug.
Also see the previous thread; A social analgesic? Acetaminophen (paracetamol) reduces positive empathy - https://news.ycombinator.com/item?id=31263305
Why should I trust someone who doesn’t test properly but just suspects?
Dominik Mischkowski is a Pain Researcher at Ohio University who has been studying this for a while. The word "suspects" here is statistical research-speak meaning there is a correlation (w.r.t. positive empathy) but more studies are warranted (w.r.t. negative empathy). That is all.
If you’re taking more meds than that without clinical supervision Id say something is wrong in the system or your medicine practices.
Where I’m from it’s common to walk to the nearest pharmacy and get meds when needed. Even over the counter stuff like paracetamols. And talking to the pharmacist. They’ll ask what you’re already taking and tell you what else to get.
Of course, we could press the fix this immediately button by requiring acetaminophen to be sold mixed with NAC but that would be too easy.
It works similarly, but stays a lot longer (half life is cited as being anywhere from 12 to 17 hours).
Acetaminophen and ibuprofen are just for temporary problems, like a headache that would go away on its own in a couple of hours.
They are uneconomic and inconvenient if you have something more persistent to keep at bay. Four ibuprofens or one naproxen? No brainer.
The main disadvantage of naproxen is that it's not approved for kids. So there is no naproxen syrup for infants or anything of the sort. Thus, you still need acetaminophen for that.